Does Medicare Cover Hospice?

Does Medicare Cover Hospice?

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Original Medicare pays the full cost of hospice services to manage pain and symptoms of a terminal illness. If you have Medicare Advantage when you enroll in hospice, you can keep your plan, but your hospice care is still covered by Original Medicare.

Medicare covers treatments for unrelated illnesses while you're on hospice, but the need for that is rare. When required, those services are paid for by Original Medicare or your Medicare Advantage plan but may not be fully covered.

How does Medicare cover hospice care?

Original Medicare covers hospice services in full, so you pay nothing for hospice care furnished by Medicare-approved providers. Medicare pays all approved hospice services when you're under hospice care, regardless of the amount charged for any given day.

Your hospice care will include needs such as:

  • Items and services for pain and symptom relief such as drugs and medical equipment
  • Medical, nursing and social services
  • Therapy services
  • Aide and homemaker services
  • Volunteer services
  • Spiritual and grief counseling for you and your family

You may pay out of pocket for related services. For example:

  • You pay a copayment of up to $5 for each prescription drug to manage your pain and symptoms.
  • You may pay 5% of the Medicare-approved amount for what are called respite services. Respite is temporary care you receive in a hospital or other facility while your caregiver gets some rest.

Once you begin hospice, Medicare won't cover things like treatments or drugs to cure your illness or care by a provider who's not set up by your hospice team. Talk with your hospice team before you get any of these services to avoid paying the cost yourself.

Original Medicare will still pay for the treatment of problems unrelated to your terminal illness, but hospice should cover most of your care.

Does Medicare cover hospice at home?

Hospice care is generally provided at home, and Medicare covers services done at home or a facility where you live, like a nursing home. Medicare pays only for comfort care and services related to your illness; it doesn’t cover housing costs such as the monthly fee for your room in a nursing home.

How long does Medicare pay for hospice care?

Medicare pays for hospice care for as long as you need it. Hospice care is for people with a life expectancy of six months or less, but if you live longer than six months, you can still get hospice care if a hospice doctor recertifies that you’re terminally ill. Your hospice doctor must recertify your need for care every 60 to 90 days.

Can I stop hospice and return to Original Medicare or Medicare Advantage?

As a patient, you can stop hospice care at any time. To stop hospice, you must sign a form that includes the date your care will end. No one else can end your hospice care on your behalf. If you had Original Medicare before enrolling in hospice, you would continue with Original Medicare after ending hospice care. If you had a Medicare Advantage plan and kept it after starting hospice, you’re still a member and can get coverage from your plan after you stop hospice care.

You can return to hospice care at any time, as long as you're eligible.

How do Medigap plans cover hospice?

Medigap plans do not pay for hospice because once you choose hospice, Original Medicare normally covers all your needs in full. You'll have no leftover hospice charges to file with Medigap. In the rare instance you require care not related to your terminal illness, Medicare Part B pays 80% and Medigap covers all or part of what's left, depending on your plan.

Does Medicare Advantage cover hospice?

Medicare Advantage does not pay for hospice services because those services are covered in full by Original Medicare. If you start hospice while you're on Medicare Advantage, you can keep your plan as long as you continue to pay your premium. But hospice care is covered by Original Medicare even while you're enrolled in a Medicare Advantage plan.

If you choose to keep your Medicare Advantage plan, you can get services not related to your terminal illness from plan providers or other Medicare providers. But you may pay all or part of the cost for nonnetwork care, and your plan may require referrals or preauthorizations. Your plan will continue to cover extra services like dental and vision if you pay your premium and follow plan rules.

Since hospice covers most of your care, you may question whether to continue paying Medicare Advantage premiums while on hospice. But if you cancel your plan and then leave hospice care later, you'll go back to Original Medicare. You must then wait for an open enrollment period to return to Medicare Advantage.

How do I find a good hospice agency?

If you're on Medicare Advantage, start by asking your insurance company to help you find a good hospice agency. If you're searching on your own, prepare a list of questions for potential hospice agencies. For example, you may want to ask:

  • How quickly do hospice staff members respond to after-hours needs?
  • What steps does your agency take to ensure quality of care?
  • How will my doctor and the hospice doctor work together to manage my care?
  • Where are hospice services provided?

You can use this Medicare resource to locate an agency near you. This site shares agency contact information along with national surveys and ratings on hospice care to help guide your decision.

Frequently asked questions

What is hospice?

Hospice is end-of-life medical care, with a focus on comfort rather than a cure. A hospice team addresses a patient's medical, physical, social, emotional and other needs and provides support to families or caregivers. To qualify, you must have a hospice doctor certify that you’re terminally ill with a life expectancy of six months or less.

Does Medicare cover 24-hour hospice care?

Yes. Medicare hospice provides coverage for a nurse and doctor who are on call 24 hours a day, seven days a week, to support you and your family when needed.

What is hospice care at home?

Hospice care at home is the same as regular hospice care but done in your home environment. In fact, most hospice care is provided in the patient's home. Medicare pays for hospice services delivered at your home or another residence, such as a nursing home.

Does Medicare Part A cover hospice?

Yes, Medicare Part A (hospital insurance) covers hospice care in full. Medical care not related to hospice is covered by Medicare Part A or Part B (medical insurance) or Medicare Advantage as appropriate.

Methodology

All information on hospice agencies, benefits, services and coverage was sourced directly from Medicare.gov and the Centers for Medicare & Medicaid Services.

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